Afraid of painful chemical peels? A Singaporean doctor allays your fears

Our skin is a huge and complex organ consisting of several discrete layers formed by different types of tissue. Some attach the skin to bone and muscle; others give skin its shape and elasticity.

Each of these layers must regenerate itself as old cells die off and new ones take their place. In the skin’s deeper layers, the body’s natural disposal systems remove dead cells. On the skin’s outer layer, the epidermis, dead cells simply rise to the skin’s surface, where they normally slough off over time.

Some dead cells, though, whether because of underlying conditions or environmental factors, remain stuck to the skin’s surface, where they can cause problems. Too deep a layer of dead skin cells can be a breeding ground for bacteria, and can trap dust and dirt that clog pores; each of these factors can lead to inflammation and swelling and can cause associated conditions like acne.

My patients are always surprised when I tell them that simply washing one’s face often isn’t enough to deal with dead skin cells. Exfoliation, whether physical or chemical, is often necessary to remove those cells and to reveal the healthier layer of live cells at the skin’s surface. Here we’ll take a look at different kinds of chemical exfoliation: the age-old method of removing dead skin cells using naturally occurring enzymes and acids.

What are Chemical Peels?

Chemical peels can be effective against a wide range of conditions, including oily skin, acne, hyperpigmentation, and even fine lines and wrinkles. They can be purchased as over-the-counter solutions or administered by beauty professionals or doctors. Whatever the setting, chemical peels deliver enzymes or acids in a gel or cream applied directly to the face. While the solution remains on the face, it dissolves the compounds that bind dead skin cells to the healthy tissue below, allowing them to be removed along with the peel at the end of the process.

Professional chemical peels often contain heavier concentrations of active ingredients than home remedies and may achieve more pronounced results more quickly. They sometimes include active ingredients that work below the layer of dead skin cells, addressing issues like pigmentation.

Almost all my patients experience and complain about minor redness or inflammation. This is to be expected. Along with the dead skin cells removed by the procedure, chemical peels may take with them some of the natural oils that keep skin supple, and surface dryness may result. These side effects are short-lived, lasting only a few days in most cases.

I usually tell my patients with sensitive skin to avoid chemical peels altogether. Other chronic conditions such as dermatitis, psoriasis, and eczema may also argue for a different approach to exfoliation. The same goes for temporary conditions such as sunburn.

What Types of Chemical Peels are Available?

Facial peeling

Different types of chemical peels, each using a different active ingredient, can treat different conditions. Some of these are available as over-the-counter remedies and through licensed doctors; in fact, the first decision many patients are faced with is whether to perform their own peels or pay a professional.

DIY peels are less expensive, of course, and are easily worked into any schedule. On the other hand, over-the-counter chemical peels are often less powerful than those available in clinics, and may not be able to treat a wide range of symptoms. They are also easier to misapply, which increases the risk of redness, irritation, and other side effects. In my professional experience, for your first treatment, it is always better to approach a licensed professional. They’ll be able to address the various questions that will inevitably pop up during such a procedure and walk you through the right approach to improving your skin.

Alpha hydroxy peels are especially useful against moderate forms of acne. They function as traditional peels, removing dead skin cells; this promotes quicker healing of acne lesions. This class of chemical peel uses lactic acid, glycolic acid, and/or malic acid; these are generally mild, but when overused can cause temporary discolouration.

Beta hydroxy acids, notable salicin, are stronger versions of alpha hydroxy acids, and peels using salicin are stronger than their counterparts. They are also used to treat acne, but since salicin is oil-soluble, it is able to penetrate more deeply than alpha hydroxy acids, addressing conditions such as acne that may have arisen in part due to an excessive buildup of dead skin cells. Salicin has antibacterial properties that further aid the healing of acne lesions. It also presents some risk of temporary discolouration. Salicin is also the active ingredient in aspirin; patients who are allergic to aspirin or otherwise must avoid it should also steer clear of beta hydroxy peels.

Jessner’s peel specializes in smoothing uneven skin tones and reducing the visual effects of hyperpigmentation. It uses a combination of lactic acid and salicin, which provides the same benefits of beta hydroxy peels and incurs the same risks.

Phenol peels are considerably more aggressive than those listed above. Based on carbolic acid, these peels work deep beneath the skin’s surface to remove dead and damaged cells and to promote the growth of new healthy tissue. Phenol peels are particularly useful against wrinkles and fine lines. Patients with sensitive skin may wish to consider other approaches, since phenol peels can cause burning and, when misapplied, even scarring.

Trichloroacetic peels are even stronger than phenol peels, addressing multiple levels of the skin. They are particularly effective at reducing hyperpigmentation and can be dramatically effective against deep acne scars, especially of the ice pick variety. While phenol peels are generally safe for people who do not suffer from sensitive skin, trichloroacetic peels may cause swelling and bruising, and when misused may result in scarring. Patients considering trichloracetic peels should allow for two or three days’ recovery time following the procedure.

How to Care for Skin After a Chemical Peel

skin care

Following a chemical peel, the skin will feel extraordinarily sensitive. Patients should limit themselves to gentle cleansers and should generously use gentle moisturizers to compensate for oils and other hydrating agents that may have been lost in the process.

Sunlight can be especially damaging to newly peeled skin, and patients who must endure sustained sun exposure should use gentle sunscreens with high SPF ratings in the days following a chemical peel. I usually tell my patients to avoid saunas and steam baths, which somewhat counterintuitively may dry skin even further.

Skin that has developed an especially deep layer of dead cells may form flakes after a chemical peel, as some dead cells become unbound without being removed with the peel’s medium. These flakes should not be picked at or removed but left to slough off naturally. If the misapplication of a powerful chemical peel has led to scabbing, those scabs should similarly be left alone and not manually removed.

Some conditions, like minor acne, are treatable with just one chemical peel. Others, like hyperpigmentation and wrinkles, may require several sessions. Peels should not be performed more frequently than once every three weeks. Any more frequently and the very cells meant to be treated simply aren’t there, leaving the peel to act on healthy tissue for which it was never intended. Among the benefits of a professionally administered chemical peel is the doctor’s ability to recommend the proper sequence of treatment for each face.